Medical Research: What is the background for this study? What are the main findings?

Dr. Shubrook: Type 2 DM is a progressive disease that is marked by declining beta cell function that results is worsening hyperglycemia. Current guidelines recommend a stepped approach in which people start with lifestyle and then sequentially add medications. The guidelines recommend that treatments be assessed regularly and titrated every 2-3 months. Unfortunately this does not happen. Clinical inertia is coming when treating diabetes where years — not months- will pass before treatments are titrated.

Time is not our friend in type 2 diabetes so we need to find a way to intervene earlier so we can see durable glucose control and hopefully longer terms preservation of beta cell function.

The INSPIRE trial (intensive insulin as the primary treatment of type 2 diabetes) tested the effect of a pulse of early basal and bolus insulin therapy on glucose control, side effects (hypoglycemia, weight gain) and beta cell function. This regimen was compared to intensive oral therapy (2009 ADA treatment guidelines0 but medications titrated monthly). In short this randomized controlled multi center clinical trials explored does a 12 week pulse of basal-bolus insulin control glucose better than 15 months of on going and monthly titrated medications.

The results showed that 12 weeks of insulin therapy (and then all treatment stopped) had similar A1c reduction and time to and need for rescue therapy compared to intensively treated on going oral medications for 15 months. Rates of hypoglycemia were low and intact those in the insulin arm lost weight while those in the medication arm gained weight.

Medical Research: What should clinicians and patients take away from your report?

Dr. Shubrook: Most important–earlier interventions has more impact. Specifically intensive early insulin can place type 2 diabetes in remission and can be safely administered without the typical side effects associated with insulin (weight gain and hypoglycemia).

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Shubrook: This study needs to be expanded. So far we have shown insulin is effective early in the disease –but this is a study-can it be done in outline care is another. I also think doing head to head trials of early intervention would be important. We would also like to see bigger studies so we can ell decide who will get the most benefit from this algorithm.

Citation:

Presented at 2015 OSTEOPATHIC MEDICAL CONFERENCE & EXPOSITION

Early Insulin Treatment for Type 2 Diabetes May Produce Better Outcomes for Patients

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